Health Insurance

Health Insurance
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Health Insurance Reform
Texans are spending more money on health insurance each year but have no idea how the health plan is spending their premium dollars. Is their premium going toward their actual medical costs or to the insurer’s bottom line? Why aren’t they protected from questionable insurance tactics that result in loss of coverage and increased out-of-pocket costs? For many employers and their employees, yearly health insurance premium increases are unsustainable. No one feels this challenge more acutely than your local neighborhood businesses, such as family-owned restaurants, auto mechanic shops, and physician practices.
Key Issues

Fact: Sheet Uniform Rx Prior-Authorization Form
HB 1032/SB 644 will streamline prescription drug prior authorizations (PAs) ensuring patients receive their medications in a more timely fashion.

Keep Insurers Honest: TMA: Appeal Your Health Plan Rankings
In spring 2011, Aetna notified El Paso plastic surgeon Deborah Seelig, MD, it was dropping her from its Aexcel physician network for not meeting certain criteria under the network's physician-ranking program.

Kitzman Suspends PPO Rules
The Texas Department of Insurance (TDI) suspended preferred provider benefit regulations until it adopts rules implementing legislation passed in the 2011 session of the legislature. A bulletin from Insurance Commissioner Eleanor Kitzman said the legislature passed bills that significantly affect TDI's ability to regulate health care plans.

Require Transparent Insurer Medical Loss Ratios
To keep insurance companies accountable to patients, it is important to focus on the medical loss ratio (MLR), how it is calculated, and how the health plans report it.

AMA: Bad Claims Payment Increasing
It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card.
Texas Advocacy and Communications

TMA Healthy Vision 2020: Establish Fair and Transparent Insurance Markets
Read TMA’s legislative strategy and recommendation for 2013 and beyond.

TMA Develops Tooklit to Help You Challenge Unfair Rankings
Physician ranking (also known as physician tiering) has traditionally been a profiling methodology used by private insurance companies to steer patients toward lower-cost physicians.

82nd (2011) Legislative Victories
TMA won important measures that prevent the further intrusion into the patient-physician relationship. Legislation was passed that would ban discretionary clauses; force health insurers to cover patient’s oral chemotherapy drugs; and ensure patients receive the medications that were prescribed by their physician, not those the least expensive to their insurer.

TMA's Legislative Testimonies
TMA physician leaders testified before state lawmakers to educate them on the importance of fair and transparent insurance markets during the 82nd session (2011).

Health Insurance Code of Conduct Act of 2009
TMA’s 2009 legislative agenda is law now due to the Patient Protection Affordable Care Act is now law.

House Bill 2256 Becomes Law
Establishes Network Adequacy Standards and Mediation Process 2009
Federal Advocacy and Communication

Federal Advocacy and Communication
TMA Comments on ACOs and Small Group Practices (Dec. 3, 2010)

PPACA: Agent Groups Fear Effects of Medical Loss Ratio Rules (May 19, 2010)

TMA Comments on Medical Loss Ratios (May 14, 2010)
RICO Settlements

RICO Settlements
Physicians Earn More Than $2 Billion From RICO Settlement (May 2012)

Health Insurance

Health Insurance Reform

Key Issues

Texas Advocacy and Communications

Federal Advocacy and Communication

RICO Settlements

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